Provider Demographics
NPI:1245207430
Name:BHAGTANI, HARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:
Last Name:BHAGTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S JEFFERSON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4418
Mailing Address - Country:US
Mailing Address - Phone:540-985-8230
Mailing Address - Fax:540-343-1012
Practice Address - Street 1:9101 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3936
Practice Address - Country:US
Practice Address - Phone:443-777-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41235Medicare UPIN